The Experience Using NexoBrid® Enzymatic Debridement at a Regional Burn Center

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Innovation in burn escharotomy methods has led to the development of enzymatic debridement formulations using anacaulase-bcdb (trademarked NexoBrid® [NXB]), a proteolytic agent derived from pineapple stems. The benefits of NXB have been well-established and range from improved patient care and burn cosmesis to decreased resource utilization and increased financial savings. While only recently approved by the FDA for commercial use in 2022, this agent has been used in Europe for well over a decade. Given the very few reports characterizing the experience with NXB in American hospitals, this retrospective review describes its use in a regional burn center and also marks the first known applications in the state of Michigan.

This retrospective chart review was approved by the Corewell Health West IRB and designated as exempt. The Corewell Burn registry was queried to identify all patients who had undergone escharotomy with NXB between January 1, 2025 and July 31, 2025. Electronic medical records were accessed to allow for review of clinical courses. The primary aim was to describe the circumstances of its utilization and the subsequent outcomes for these patients. Secondary objectives were to describe trends in hospital length of stay, pain control, and rate of re-epithelialization. Basic statistics were performed for limited analysis, although no attempts were made at determining statistical significance given the small sample size and nature of the study.

Eight patients met the criteria for inclusion. Two patients, one of whom was coagulopathic, underwent successful enzymatic debridement of full- thickness burns while critically ill and too hemodynamically unstable for surgical debridement. A third critically ill patient had successful application of NXB, but this initial debridement was delayed one day due to hemodynamic variation with shifting in bed. One patient presented with thick eschar over his lower leg 11 days after the burn was sustained; NXB application provided almost no debridement in this individual. Pain was well-controlled in all cases; four patients were already intubated and sedated, 3 underwent popliteal and adductor canal nerve blocks, and one received a supraclavicular nerve block. In-hospital mortality for the cohort was 25%. Among surviving patients, average length of stay was 11 days and average percent wound closure at discharge was 42%.

Our experience suggests that enzymatic debridement is a safe alternative to surgical debridement and effective in the majority of cases. Its utilization is well-tolerated in multiple body regions, and the associated pain can be adequately controlled on the general floor and in the ICU. NXB has the potential to decrease hospital LOS and operative interventions, but its effects may be diminished in especially thick or older eschars. Future studies should compare the outcomes of cohorts in American hospitals.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2083

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